Treatment of Selective Mutism

Treating Selective Mutism is difficult, likely because the behavior is an effective strategy for reducing children's anxiety feelings. Children's mutism reduces their profile in threatening settings. From a behavioral perspective, this behavior is often negatively reinforced by people around the child. In other words, as children continue to refrain from speaking in threatening settings, the people they interact with start to accept the mutism and stop expecting the children to speak. Children quickly learn that they can get people to stop bothering them simply by being persistent in their muteness. For a more detailed explanation of negative reinforcement and other principles of learning theory, please click here.

Many effective anxiety treatment strategies are also useful for treating Selective Mutism. In particular, behavioral modification plans can be quite effective. A clinician creating a behavior modification plan for treating Selective Mutism would first identify and differentiate settings and people with whom the child refuses to speak. Next, the clinician would develop a reinforcement/reward system that would reward appropriate behavior (any effort to speak in appropriate settings/situations). The behavior plan might use a token system, where the child receives tickets or stickers for desirable behaviors. Later on, the children can trade tickets or stickers for candy, toys, or privileges of their choosing.

Desensitization strategies (such as those we described in the discussion on Pica) are also likely to be included in the behavior plan to help children feel more relaxed and able to tolerate situations and settings that they find particularly threatening. Through these procedures, children gradually learn that an object or person is not actually a threat. At this point, Mutism should decrease, as there is no longer a need to use this type of behavior to cope with anxiety (i.e., the child has more adaptive stress-coping skills).

Antidepressant and anti-anxiety (anxiolytic) medications have also been used to treat Selective Mutism. Tricyclic antidepressants such as Clomipramine and Imipramine (i.e., members of the older generation of antidepressants that existed before SSRIs like Prozac), and anxiolytics such as Clonazepam (a habit-forming benzodiazepine) and Buspirone (another kind of anxiolytic) are often tried. All of these medications have side effects associated with them and must be taken with care and as prescribed by a licensed physician. In addition, antidepressants currently carry a "black box" warning because their use with children has been linked to a small increase in the risk of suicidal behavior and completed suicides. Because of this small but elevated risk of suicide, children who are prescribed antidepressant medications should also be meeting regularly with a mental health clinician experienced in the treatment of children in order to monitor their potential for suicidal thoughts and behaviors. It is always a good idea to talk with your doctor about the full range of potential risks and benefits associated with recommended medications before agreeing to allow your child to take them.